02070091 CITY OF CUPERTINO
BUILDING DIVISION PERMIT '. CONTRACTORINFORMATION:
BUILDING ADDRESS: PERMIT
10232 PARLETT PL MICCICHI MASONRY N°02070091
SING H AND WANG CHIEN Y 665 BEL AIR APPLICATII�1J7T/9E/2002
(408) 219-5964
HONE: SANITARY NO.. o CONTROL NO.
EG O z ARCHITECTIENGINEER: BUILDING PERMIT INTO
I,u BLDG ELECT PLUMB MECH
u
;� i LICENSED CONTRACTOR'S DECLARATION IDS
v Ihcrtbyalfim,thulamlicoudundcrprovisionsofCM1vpmr9(commencing FHA STRAP & RE)3KKe5f'pOF LINE
is in m_ wilo Suction]Od fDirision3of the Busine�sspand Professions Coda and mylicense
¢sec LinnselCgre pod rYe^i.7 y Lic/ C-tZ-S LkCpS. ���g q ■ E®
as n F �DDc /1�•' C Cnmrnn G a!A Woe
g✓� W MeTION
y,yn;plans shall be used as public records ords
id o� LicenslJ' -.sio Jtll 2 3 2002
n u. OWNER-BUILDER DECLARATION
1 hereby affirm that 1 amufrom the Conuacmr i License for,he BUILDING$
C? fnllwing reason.(Section]011.5..Business
ess and Rofcxsiom Code:Any cityty or county
....
Y x o which requires 0 Permit Or convraa,ol¢n improve,demolish,or repair.,svuctum
�3� -prioroiusmarce,also rhea t for such permit to file o signal statement _. erre_
,requires isionsn r•�cm c�� tt�
1Wt�,iitlicedied puisuanuoihe govivons of the Conwnars License lsw(Chvger9 3*6Y1u146Rn.A34d 1
(commencing With,Section]OW)of Division Sof the Business and Professions Code) I, lu` i l t C'r' Valuation
or Ihot Fe is unmet lolicfrrini and the basis for the alleged einngion.AnY violation ' ' ��'t.\t_ s s.j'+. Lt's L s.. \.:l.'„r i.�.. .'
-'of Secdon 7031.5 by any oppliont for a permit subjects the applicant to a civil penalty
arot mnie,n.n five nanarta dmlars asoo). 1 OAPP+N51AAWDATi ON 'rT:: Occupancy Type
❑Las o+nerof me progeny.or my employes whh wage.ax thdrxde compenmtion, 312 - CHIMNEY REBAR & STRAPS
will Edthe-work:'oad the.someone is not intended'br'oReredfor sole(S.:70,t,' PF
Business and Pmfasions Code:The Contmelor's License Low does not apply,o an I $I •'
0
water of pm«ny Who builds or imamwi Ihemon,and who does such work himself
of througgh his own however.t provided that such improvements art not intended or -_. _--
.oRcicdf _. - __. - .- _ .. ... ��\..I:.,-,�.�_.___.__ peer-_........ _ prop_
r rile.If,however,the building m improvement n sold within one yew of rl. :
cniprew far the owner-builder will have the burden of proving that he did not build or
improve for purpose of
mpl
e. .
,.__. __..... _ ._.__. -
Ell, ownerof,he property,am exclusively contracting moonro.,s_to--. .._. _..
I.
onswct the project(See.704,4.Business and Professions Cade:) p,eh.eS
IC.- ------ -
The Contractor's e"w .1-FC't
Ucense Low does not apply to an owner of property who Wilds or impmvs theron, '
and who.contractsfor s«h pmjec%s ith.a.co vactods).licensed puramem to the .- _.repo_ . .. .. .. _ _ _ p oor_.
ConwmorsL cense Low . .. »-- "'--'--
Olamexempt underSec - t �.B&P C far this
- .r ]..,.
Owner. at.
WORKER'S COMPENSATION DECLARATION
I hereby affirm under penalty of perjdry otic of the following declarations:-
I have pod will moimain a Certificate of Consent to self-insum for Worker's
Compensation, as providead for by Section 3700 of the Labor Code. for the
_ o fie monce'.f the work for which this permit is issued. .
❑1 ha Wand will maimain,Warkei s Cnmpetuaiimi bitumnce,as required by,Section
it Be,
a ofwork Tor which thisu
pcmdt
ss ed My kers Compensation 1 '
3](p of the Labor Code f the pert omaant !, icy
e ams end Pol
/j
Jf poor . . _ poor
" CERTIFICATION OF EXEMPA6N FROMIWORKERS ' s.. i°• D� f � . te.. \a \ s r -
1 COMPENSATION WSURANCE," �,'
.. ._...trop _repo _".,___.._ -_•___...� ._......._.-_torp._ _ poop_.-..-..- __-..-_poop..poop_._.
Ir it t pits s«iion need not be mmplcted if the permit is for o«hundred dollars
'' - "" '• it riL:`'.: `,��J"
1E100)err Icss.) t
I can fy th t to perfumta of tM work for hich th s permit is issued.
shallnot employ any person in any manner so,asnto become subject to the W«ken
mp
Coensation Law,of California'Date"
Applicant.v. 'i..`,..1.„ .., - .. ..__ .,--.-_ -
NOTICE TO APPLICANT:IL after ma.,timthis Ccninsof b Lidice Exemption. should
st ..
WFome it comp m the Workers Colons Or this
provisions of the Labor Code,d. muni
0 0 fonhwiN comply with such provisions or this permit shall be deemed revoked.
'CONSTRUCTION LENDING AGENCY
ai � 1 h hy'Rmi that lo ts a coneomn I ding agody fo the pert' one ' ..
kii.
i ofd¢work!e — loll.... ..is issued(See 3097.Civ.C.)'
SQ -Lender's Name -poor......n_.,........ .....__.•,-:.prop.
",Address
7:Z
V 0 ,I certify that 1 have mail this applic tion and state that above information is
I, (.., corrtn,l agree to,comply with all city and county ordinances and state laws]dating
o..f, to Wilding commuctiogand heieby amhoriee rtyasmatives of this city to enter upon
the abov(We em)aeng,reoenetotl epmepry f fypatmtl
d Purpose
d6im _
keep humleu the City of Cupen o ejamat
V-fn liabilities,judgments costs and expenses which may n any way serve against mid l �/
rZ. Cityi- s qucn0I of the grant g ohhti perm t "- `
NDER.TA.\bjN9LL CO\1PLY-N ITH ALL O\'POIAT r
s r [�—a Issued by: Date
S t J`Applinm/ConGacmr', it"` •.....`..• "'.Due..•:.•.
HAZARDOUS MATERIALS DISCLOSURE Re-roofs
W ll the sept m«(uturc Wdtlmg«cupam note or hurdle huartlous mumil .Type Of ROOF. r as,
def M by the C penins M ,deal Code.Chapmr 9 12,end Ne He.IN e d Sofcry - - \• '
Cade:OY 25532(.)T� ... .
All roofs shall be.mspected..prior to,any,roofing.material.being installed.,._
Will On..pph ani w'fuma WimmgOccupant use equipmento devices which If a roof is installed without first obtaining an inspection;I agree.to'remove
Air Quality Ma agement
mtti ? s conumr sntsudefincd b the B. Art. ,, all new materials for inspection. Applicant understands and will comply with
r flay
0Yes N . . . _ poop ._.__...-..
poop_ poop _._ .�_ _..
s t �f f all non-point source regulations.
1 M1 e ' 'theh undoes ma¢riah'rtgwremenu undo Ch p¢ 695 of Ne
C lifam cel &'Safety Code Sectio ns 25505,25533 and 25534 1 understand lost
..
-if Ne pu' g as ata curicn0y haw ucnmt,tis'hat itis mymaroosibility isnotify
«c' f e'iequi menti wNth mutt be Trdor to iuvevice a Certificate of of
Signature.of Applicant -- , . Date
_repo
r lo n=ea?gtm
Do All All roof coverings to be Class "B" or better
Ir, y.:'iit
. ; -k ,. _ _�, .. -_ .'. . . .- OFFICE